动态腕手矫形器应用于慢性期脑卒中患者上肢及手功能康复的疗效

doi:10.3969/j.issn.1006-9771.2019.11.019

《中国康复理论与实践》 ›› 2019, Vol. 25 ›› Issue (11): 1361-1364.doi: 10.3969/j.issn.1006-9771.2019.11.019

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动态腕手矫形器应用于慢性期脑卒中患者上肢及手功能康复的疗效

杨名珍¹, 黄崧华², 白玉龙^1,2

1.复旦大学附属华山医院康复医学科，上海市 200040
2.复旦大学附属华山医院北院康复医学科，上海市 201907

收稿日期:2019-05-16 修回日期:2019-07-10 出版日期:2019-11-25 发布日期:2019-11-21
通讯作者: 白玉龙，E-mail： dr_baiyl@126.com E-mail:dr_baiyl@126.com
作者简介:杨名珍(1990-)，女，回族，山东济南市人，硕士，医师，主要研究方向：神经系统损伤康复。
基金资助:
1.上海市科学技术委员会科研项目(No. 17511107802)；2.华山医院北院院内课题(No. HSBY2017014)

Application of A Dynamic Wrist-hand Orthosis for Upper Limb and Hand Function Rehabilitation in Chronic Stroke Patients

YANG Ming-zhen¹, HUANG Song-hua², BAI Yu-long^1,2

1.Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, 200040, China
2.Department of Rehabilitation, Huashan Hospital North, Fudan University, Shanghai 201907, China

Received:2019-05-16 Revised:2019-07-10 Published:2019-11-25 Online:2019-11-21
Contact: BAI Yu-long, E-mail: dr_baiyl@126.com E-mail:dr_baiyl@126.com
Supported by:
Supported by Shanghai Science and Technology Committee Research Program (No. 17511107802) and Huashan Hospital North Research Program (No. HSBY2017014)

摘要/Abstract

摘要： 目的应用一种动态腕手矫形器(Saebo Glove康复手套)辅助慢性期脑卒中患者上肢及手的抓握、伸展训练。方法 2018年10月至2019年1月，脑卒中慢性期上肢及手功能障碍患者11例，在常规康复训练的基础上佩戴动态腕手矫形器后进行抓握、伸展训练，共3周。比较训练前后腕背伸肌、腕掌屈肌肌电值；采用Fugl-Meyer评定量表上肢部分(FMA-UE)、手臂动作调查测试(ARAT)、屈腕肌改良Ashworth量表(MAS)、改良Tardieu量表(MTS)和三倍痉挛量表(TSS)进行评定；测量握力，主动屈、伸腕关节，屈掌指关节活动度。结果治疗后，患者FMA-UE和ARAT评分、主动腕背屈活动度增大，腕屈肌TSS评分下降(t > 2.739, P < 0.05)。结论动态腕手矫形器辅助下抓握、伸展训练可提高慢性脑卒中患者上肢和手的运动功能，降低屈腕肌痉挛。

关键词: 脑卒中, 上肢, 手, 腕手矫形器, 运动功能, 痉挛

Abstract: Objective To observe the effect of grasping training under a dynamic wrist-hand orthosis (Saebo Glove) on upper limb and hand function in chronic stroke patients. Methods From October, 2018 to January, 2019, eleven patients with hemiplegia in upper limb and hand after chronic stroke were recruited. They received conventional rehabilitation and grasping training under dynamic wrist-hand orthosis for three weeks. They were tested surface electromyography of flexor and extensor muscle of wrist and upper limb, assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Reach Arm Test (ARAT), modified Ashworth Scale (MAS), modified Tardieu Scale (MTS) and Triple Spasticity Scale (TSS), and measured grip force, active range of motion of wrist and metacarpophalangeal joints before and after treatment. Results The scores of FMA, ARAT and TSS, and active range of motion of wrist flexor improved after treatment (t > 2.739, P < 0.05). Conclusion Grasping training assisted with dynamic wrist-hand orthosis can improve upper limb and hand function of motor and release spasticity in hemiplegics after chronic stroke.

Key words: stroke, upper limb, hand, wrist-hand orthosis, motor function, spasticity

中图分类号:

R743.3

杨名珍, 黄崧华, 白玉龙. 动态腕手矫形器应用于慢性期脑卒中患者上肢及手功能康复的疗效[J]. 《中国康复理论与实践》, 2019, 25(11): 1361-1364.

YANG Ming-zhen, HUANG Song-hua, BAI Yu-long. Application of A Dynamic Wrist-hand Orthosis for Upper Limb and Hand Function Rehabilitation in Chronic Stroke Patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2019, 25(11): 1361-1364.

参考文献

1 BroeksJ G, LankhorstG J, RumpingK, et al. The long-term outcome of arm function after stroke: results of a follow-up study [J]. Disabil Rehabil, 1999, 21(8): 357-364.
2 NakayamaH, JorgensenH S, RaaschouH O, et al. Compensation in recovery of upper extremity function after stroke: the Copenhagen Stroke Study [J]. Arch Phys Med Rehabil, 1994, 75(8): 852-857.
3 NakayamaH, JorgensenH S, RaaschouH O, et al. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study [J]. Arch Phys Med Rehabil, 1994, 75(4): 394-398.
4 宝金才,陈晁,陈晓亮. 分指板结合康复治疗对脑卒中后手指痉挛的影响[J]. 医药前沿, 2012(32): 96.
5 杨薇,辛宁,孙玉珍,等. 自制分指板在脑卒中偏瘫患者康复护理中的应用[J]. 护理学杂志, 2012, 27(1): 81-82.
6 TurtonA J, BrittonE. A pilot randomized controlled trial of a daily muscle stretch regime to prevent contractures in the arm after stroke [J]. Clin Rehabil, 2005, 19(6): 600-612.
7 中华神经科学会,中华神经外科学会. 各类脑血管疾病诊断要点[J]. 中华神经科杂志, 1996, 29(6): 379-380.
8 LiF, WuY, XiongL. Reliability of a new scale for measurement of spasticity in stroke patients [J]. J Rehabil Med, 2014, 46(8): 746-753.
9 KwakkelG, KollenB J, van der GrondJ, et al. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke [J]. Stroke, 2003, 34(9): 2181-2186.
10 ThantA A, WanpenS, NualnetrN, et al. Effects of task-oriented training on upper extremity functional performance in patients with sub-acute stroke: a randomized controlled trial [J]. J Phys Ther Sci, 2019, 31(1): 82-87.
11 GandolfiM, ValeN, DimitrovaE K, et al. Effects of high-intensity robot-assisted hand training on upper limb recovery and muscle activity in individuals with multiple sclerosis: a randomized, controlled, single-blinded trial [J]. Front Neurol, 2018, 9: 905.
12 MortensonW B, DemersL, FuhrerM J, et al. How assistive technology use by individuals with disabilities impacts their caregivers: a systematic review of the research evidence [J]. Am J Phys Med Rehabil, 2012, 91(11): 984-998.
13 刘维红. 手部矫形器分指板对脑卒中早期患者手功能恢复的影响[J]. 中华物理医学与康复杂志, 2014, 36(5): 399-400.
14 张立峰,张慧,刘妍妍,等. 自制腕指康复板对脑卒中患者腕手功能恢复的影响[J]. 中国康复, 2014, 29(1): 71-73.
15 LanninN A, HerbertR D. Is hand splinting effective for adults following stroke? A systematic review and methodologic critique of published research [J]. Clin Rehabil, 2003, 17(8): 807-816.
16 TysonS F, KentR M. The effect of upper limb orthotics after stroke: a systematic review [J]. NeuroRehabilitation, 2011, 28(1): 29-36.
17 AndringaA, van de PortI, MeijerJ W. Long-term use of a static hand-wrist orthosis in chronic stroke patients: a pilot study [J]. Stroke Res Treat, 2013, 2013: 546093.
18 StuckR A, MarshallL M, SivakumarR. Feasibility of SaeboFlex upper-limb training in acute stroke rehabilitation: a clinical case series [J]. Occup Ther Int, 2014, 21(3): 108-114.
19 WooY, JeonH, HwangS, et al. Kinematics variations after spring-assisted orthosis training in persons with stroke [J]. Prosthet Orthot Int, 2013, 37(4): 311-316.
20 LanninN A, CusickA, HillsC, et al. Upper limb motor training using a SaeboTM orthosis is feasible for increasing task-specific practice in hospital after stroke [J]. Aust Occup Ther J, 2016, 63(6): 364-372.
21 NijenhuisS M, Prange-LasonderG B, StienenA H, et al. Effects of training with a passive hand orthosis and games at home in chronic stroke: a pilot randomised controlled trial [J]. Clin Rehabil, 2017, 31(2): 207-216.
22 NowotnyJ, El-ZayatB, GoronzyJ, et al. Prospective randomized controlled trial in the treatment of lateral epicondylitis with a new dynamic wrist orthosis [J]. Eur J Med Res, 2018, 23(1): 43.
23 RicciF, McKeeP, ZamparA C, et al. Enhancing function after radial nerve injury with a high-profile orthosis and a bio-occupational orthotic framework [J]. J Hand Ther, 2019. DOI: 10.1016/j.jht.2018.09.003.
24 FarrellJ F, HoffmanH B, SnyderJ L, et al. Orthotic aided training of the paretic upper limb in chronic stroke: results of a phase 1 trial [J]. NeuroRehabilitation, 2007, 22(2): 99-103.

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动态腕手矫形器应用于慢性期脑卒中患者上肢及手功能康复的疗效

Application of A Dynamic Wrist-hand Orthosis for Upper Limb and Hand Function Rehabilitation in Chronic Stroke Patients

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